From hysteria to hindsight: the Maldives lockdown legacy after five years

The Malé lockdown came hours after community transmission of the novel coronavirus was confirmed on April 15, 2020. Schools closed, businesses shuttered and prayer congregations were suspended. Movement restrictions remained in place until mid-June.

"Everyone was afraid. There was so much misinformation about the virus," a senior Health Protection Agency official recalled. "I remember the first death in the Maldives and the aftermath. Questions were asked about how to conduct the burial rites. Whether it was safe. They [undertakers] were freaking out. It was hysteria." 

Amid fears of an outbreak overwhelming hospitals and potentially causing thousands of deaths, decisions made in those uncertain early days followed the advice of the World Health Organisation, which recommended the “uncompromising and rigorous use of non-pharmaceutical measures” employed by China to contain the spread of Covid-19 in Wuhan. 

But experts now question whether such extreme measures were justified. In a new book, two prominent Princeton University political scientists argued that there was no clear evidence that “non-pharmaceutical interventions” such as border closures, quarantines or lockdowns saved lives, highlighting the unfair distribution of benefits and harms that hit essential workers and under-privileged families the hardest. 

The human cost of the Malé lockdown ranged from economic devastation to increased domestic violence, widespread mental health challenges, and lasting damage to children’s development, illustrating the complex trade-offs in balancing immediate public health imperatives against long-term consequences. 

The swift implementation of the lockdown was a necessary measure "driven by epidemiological risk assessments that projected a potentially catastrophic scenario with up to 30,000 individuals requiring critical hospital care,” Umar Fikry, the former deputy chief of the National Disaster Management Agency, told the Maldives Independent.

The capacity of the Maldives healthcare system fell far short of dealing with the hospitalisation and critical care projected by models. 

The lockdown of the Greater Malé Region – home to 212,138 people or 41 percent of the country’s population – along with a ban on travel between islands successfully curbed the spread of the diseases, Umar said. But he acknowledged the losses suffered by individuals and families.  

"In my own experience, with a two-year-old son who had previously met all his developmental milestones, including speech development, the four-month lockdown in Malé City led to a significant regression in his speech abilities, almost to the point of complete loss,” he said. 

“This personal experience underscores the often unseen toll of such restrictive measures, demonstrating that while my family may have been protected from the immediate threat of Covid-19, the lockdown left my son with a developmental delay that will likely require years of intervention to overcome.”

Lockdowns could be viewed primarily as a means to reduce human interactions in order to limit virus transmission, explained Dr Sheena Moosa, a public health expert who served as a consultant for the National Emergency Operations Centre set up by the NDMA and HPA to adopt the “whole-of-government” approach championed by the WHO.

"If we take this view and the context at the time of the start of the pandemic, what we (science) knew about the virus, the disease and its death rate, medical products available for preventions and treatment, human behaviour and health systems capacity in our country, the lockdown (not qualifying the level of strictness) implemented in the Maldives did have an impact on providing time for health system readiness, development of vaccine and other testing and treatment products that saved lives," she told the Maldives Independent.

But whether the benefits outweighed the social and economic costs was a more difficult question. "How do we value a human life that could have been saved? I believe it definitely was an ethical dilemma for the decision makers of COVID-19 response," she observed.

A senior member of the Technical Advisory Group – a team of epidemiological experts and leading healthcare professionals that advised the government on the emergency response – concurred with Dr Sheena.

"You have to remember that this is happening in front of us with, I would say, little space for maneuvering because of the urgent nature that any action demands. So after it is all over, in hindsight, we can say this worked or not. I do not think that means that lockdowns were not effective. At that point in time, considering the outbreak, the death rate – the priority was saving lives," she said.

The Covid-19 death toll reached 48 by the end of 2020. The total number of deaths stood at 316 in December 2023.

The stay-at-home order came just after Ahmed Hamdhan’s eight-year-old son started the second grade.

"The whole thing with meeting new friends his age. That was exciting. Then suddenly, no school, no park or bike rides or anything. There are no other kids at home. So I think, even though we were there he felt lonely," said Hamdhan, a civil servant. 

Like thousands of other children, most of whom lived in small apartments, Hamdhan’s son spent nearly seven months indoors before parks and playgrounds reopened in early November 2020. 

"It was like he had forgotten how to interact with kids his age and because of online classes and access to the tablet, he was very used to it and would get angry when we tried to reduce screen time," he recalled.

A large majority of children missed going to school the most, a UNICEF survey found.

With the border closed and resorts shut down, the tourism-dependent economy contracted by an unprecedented 33.5 percent – the third worst plunge in the world in 2020. 

With the inclusion of the expatriate workforce, more than 45,000 people in the multi-billion dollar tourism sector were affected through terminations, no-pay leave or wage cuts.

A rapid livelihood assessment by the UNDP found "an average income loss ranging from US$ 600 to US$ 1,000 per month for the period April – June 2020." 

The World Bank estimated a 10.5 percent rise in the poverty rate.

More than 22,000 people applied for an income support allowance scheme that disbursed MVR 421 million (US$27 million). 

"As soon as I found out about it, it was like the world had ended. I am a grown man who was in tears. Just like that we were told we will be paid only MVR 1,000 for the upcoming months," Rasheed Hassan, a Villa Hotels employee, recounted to the Maldives Independent, describing the impact of losing his previous average salary of US$ 400 a month.

"I could not deal with the shame of not being able to provide for my family. They [wife and two children] were living in a shared rent apartment in Malé. I could not pay rent or do anything. As soon as they allowed it, we moved back to our island. By then I was in debt."

Hassan's story reflected the plight of thousands of resort workers, 42 percent of whom could not pay rent, 71 percent were unable to pay utility bills and 57 percent could not afford groceries, according to a Maldives Statistics Bureau survey.

During the one and half months of complete lockdown, the social services ministry provided temporary shelter to 500 individuals evicted over failure to pay rent. 

But with family protection services unavailable during the lockdown, many survivors of domestic violence fell through the cracks. Low reporting of domestic abuse during the period masked a brutal reality. 

"We had a lot of reports of abuse, soon after the lockdown was lifted. You can see from the reports to us and from the police, we were not able to reach them and they were stuck at home with the perpetrators,” a key informant from the social protection services explained in a survey on societal impact.

“At first we thought with other family members also staying at home, such incidents decreased, but sadly it was not so."

The exacerbation of existing socio-economic problems also led to an increase in people seeking mental health support. During the lockdown period, more than 3,000 people sought support through a system established by the Maldivian Red Crescent to provide psycho-social first aid, which served as a reference point to the National Mental Health Centre.

"The social sectors were unprepared to respond to the pandemic and almost all the sectors were detached from the core emergency response and responded separately," the social impact report concluded.

Officials at the National Emergency Operation Centre also responded to distress calls from migrant workers who described conditions in accommodation blocks cut off from meal delivery services and contact with employers. In some cases, migrant workers under lockdown went hungry for days.

Dr Sheena stressed the social protection interventions included in the pandemic response, which had been aimed at "ensuring equity, not leaving people behind." 

Institutions have learned lessons from the Covid-19 crisis in the Maldives, she suggested.

“It may take another century for a pandemic of this level and most of us are unlikely to be around to share our experiences and lessons,” she observed.

“The lessons need to be integrated into emergency and disaster planning and capacity building interventions for preparedness. A few publications are available highlighting overall lessons learnt, but operational experiences will fade into oblivion unless they are systematically incorporated into national and sectoral response plans, documented and archived." 

  

Timeline Series: this is the first in a series of articles looking back at the stories we missed during our five-year hiatus.